Meningococcal disease

What

Meningococcal disease is caused by the bacterium Neisseria meningitidis. The bacterium is commonly known as meningococcus.

There are 13 known meningococcal serogroups, distinguished by differences in surface polysaccharides of the bacterium’s outer membrane capsule. Globally, serogroups A, B, C, W and Y most commonly cause disease. 

Invasive meningococcal disease (IMD) is a rare but serious disease. It most commonly presents as septicaemia and/or meningitis.

Who

Meningococcal vaccines are recommended for:

• infants, children, adolescents and young adults
• special risk groups, including Aboriginal and Torres Strait Islander people, individuals with certain medical conditions (see List. Specified medical conditions associated with increased risk of invasive meningococcal disease), laboratory workers who frequently handle Neisseria meningitidis, travellers, and young adults who live in close quarters or who are current smokers

How

Several vaccines are available in Australia to prevent meningococcal disease. However, no single vaccine protects against all serogroups: 

• 2 vaccines protect against meningococcal serogroup B — MenB vaccines.
• 2 vaccines protect against meningococcal serogroup C only — MenC vaccine and Hib-MenC vaccine (combined with Haemophilus influenzae type b).
• 3 vaccines protect against meningococcal serogroups A, C, W and Y — MenACWY (quadrivalent) conjugate vaccines.

Why

Although it is rare, IMD is a serious infection that can cause significant illness, disability and death. Vaccination programs have successfully reduced the incidence of IMD caused by serogroup C. However, IMD caused by serogroup B continues to occur in Australia, and the incidence of IMD caused by serogroups W and Y has increased in recent years.

See

• Infographic. Meningococcal vaccination for children and adolescents without risk factors
• Infographic. Meningococcal vaccination for people in a special risk group

Meningococcal vaccines available in Australia

The Therapeutic Goods Administration website provides product information for each vaccine.

See also Vaccine information and Variations from product information for more details.

Dose and route

The dose of all meningococcal vaccines is 0.5 mL given by intramuscular injection.

Co-administration with other vaccines

MenACWY vaccines

MenACWY vaccines can be co-administered with most other vaccines. However, there are some limitations for concomitant administration of Menactra (see below).

MenACWY vaccines are safe to use with most other vaccines given in childhood^11-21 and adolescence.^22-26

In most studies, the frequency of reactions after vaccination was similar regardless of whether the vaccines were received together or separately. Some studies showed slight increases in mild reactions when vaccines were given together.

If a person needs to receive Nimenrix and a vaccine containing tetanus toxoid (such as Infanrix hexa), co-administration of these vaccines is preferred. Giving Nimenrix after a vaccine containing tetanus toxoid may interfere with the immune response against some meningococcal serogroups. There is uncertainty about whether this reduced immune response affects clinical protection, and there are no data on the optimal interval between the vaccines. Therefore, Nimenrix should be given as scheduled, even if it is being given shortly after a vaccine containing tetanus toxoid. 

Co-administration of Menactra (MenACWY vaccine) with 13vPCV should be avoided. This is because Menactra may interfere with the immune response against some pneumococcal serotypes. Menveo or Nimenrix can be co-administered with 13vPCV.

If a person needs to receive Menactra and 13vPCV, the vaccines should be given at separate visits, especially if the person has a medical condition that increases their risk of meningococcal and/or pneumococcal disease. It is preferred that they receive 13vPCV first, followed by Menactra at least 4 weeks later. If 13vPCV and Menactra are inadvertently co-administered, a repeat dose of either vaccine is not needed. If the person has a condition that increases their risk of pneumococcal disease (see List. Specified medical conditions associated with increased risk of invasive meningococcal disease), 23vPPV should be administered as scheduled.

If a person needs to receive Menactra and a vaccine containing diphtheria toxoid, it is preferred that either Menveo or Nimenrix is administered instead of Menactra. If the other MenACWY vaccines are unavailable, co-administration of Menactra and the vaccine containing diphtheria toxoid is preferred, rather than delaying either vaccine. Giving Menactra after a vaccine containing diphtheria toxoid may interfere with the immune response against some meningococcal serogroups. There is uncertainty about whether this reduced immune response affects clinical protection, and there are no data on the optimal interval between the vaccines. Therefore, Menactra should be given as scheduled, even if it is being given shortly after a vaccine containing diphtheria toxoid.

MenB and MenACWY vaccines can be co-administered at any age.

MenB vaccines

Bexsero can be safely given with other routine vaccines.

Children <2 years of age have an increased risk of fever if Bexsero is co-administered with other routine vaccines, compared with when these vaccines are given separately (see Adverse events). 

However, this is not a contraindication to co-administration of Bexsero with other vaccines. Children <2 years of age are recommended to receive prophylactic paracetamol if they are receiving Bexsero. See Contraindications and precautions.

Children <2 years of age can receive Bexsero separately from other routine infant vaccines, with a minimum interval of 3 days, to minimise the risk of fever. Prophylactic paracetamol should still be used. See Contraindications and precautions. In this case, give routinely recommended vaccines first.

Adolescents can safely receive Trumenba at the same time as other vaccines given in adolescence, including HPV (human papillomavirus) vaccine²⁷ and dTpa vaccines.²⁸

MenB and MenACWY vaccines can be co-administered at any age.

Interchangeability of meningococcal vaccines

MenACWY vaccines

If possible, complete the primary course of MenACWY vaccination with the same vaccine brand. If this is not possible, use an alternative brand following the dose recommendations by age. See Recommended dose schedules.

People can receive booster doses of MenACWY vaccine using any brand. Menveo or Nimenrix are preferred to Menactra in people aged ≥2 years.

MenB vaccines

Bexsero (MenB-MC) and Trumenba (MenB-fHBP) are not interchangeable. Use the same vaccine to complete the vaccination course.

Contraindications

The only absolute contraindications to meningococcal vaccines are:

• anaphylaxis after a previous dose of any meningococcal vaccine
• anaphylaxis after any component of a meningococcal vaccine

Previous meningococcal disease, regardless of the serogroup, is not a contraindication to receiving any meningococcal vaccine.

Previous vaccination with the strain-specific MenB vaccine used in New Zealand (MeNZB) is not a contraindication to receiving either Bexsero or Trumenba.

Previous vaccination with a quadrivalent polysaccharide meningococcal vaccine (4vMenPV; used previously in Australia) is not a contraindication to receiving any MenACWY vaccine. See ‘People who have previously received a meningococcal polysaccharide vaccine’ in Laboratory workers or Travellers.

Precautions

Prophylactic administration of paracetamol with Bexsero vaccination in children aged <2 years

Children <2 years of age are recommended to receive prophylactic paracetamol with every dose of Bexsero. This is because of the increased risk of fever, including high fever, after receiving Bexsero^29,30 (see Adverse events). This is an exception to the general recommendation to not routinely give paracetamol at the time of vaccination (see Adverse events following immunisation).

The 1st dose of paracetamol (15 mg/kg/dose) is recommended within 30 minutes before, or as soon as practicable after, receiving the vaccine. This is regardless of whether the child has a fever. This can be followed by 2 more doses of paracetamol given 6 hours apart, regardless of whether the child has a fever.

A clinical trial showed that using paracetamol prophylactically in infants reduced the likelihood of high-grade fever by about half after any vaccine dose. This had no overall impact on the immune responses to either Bexsero or other vaccines given at the same time.³¹

Similarly, prophylactic antipyretics reduced the likelihood of fever in the first 48 hours after the 1st dose of Bexsero by about 50% among more than 1500 children <2 years of age.³² This was seen in a population-based MenB vaccination program using Bexsero in a region of Quebec, Canada (see Adverse events).

Women who are pregnant or breastfeeding

Meningococcal vaccines are not routinely recommended for pregnant or breastfeeding women,^33,34 but can be received where clinically indicated. See Vaccination for women who are planning pregnancy, pregnant or breastfeeding.

People with latex allergy

The product information for Menveo states that the tip cap of the syringe contains natural rubber. The risk of allergy is lower from natural rubber than from latex. However, consider using an alternative product in people with an allergy or sensitivity to latex.

MenACWY vaccines

Meningococcal ACWY vaccines have been shown to be safe in multiple clinical trials and large population studies (conducted in countries after the vaccines became available) in people of different ages, from infants to adults.^11-15,35-45 Most reactions after vaccination are mild and resolve on their own. Meningococcal ACWY vaccines are safe for use in people with HIV.^46,47

Meningococcal ACWY vaccines can be safely administered at the same time as other routine vaccines provided to young children through the National Immunisation Program. In most studies, the frequency of reactions after vaccination was similar regardless of whether the vaccines were given together or separately. Some studies showed slight increases in mild reactions when vaccines were given together.

Meningococcal conjugate vaccines are not associated with Guillain–Barré syndrome (GBS). An early report in the United States of a suspected temporal association between Menactra and GBS was followed by 2 large retrospective cohort studies in the United States. These studies found no evidence of an increased risk of GBS after receiving Menactra.^48-50 People with a history of GBS can receive meningococcal conjugate vaccines if indicated.

Menveo

Clinical trials have shown that Menveo is safe to use in infants, children and adolescents. Most adverse events are mild or moderate. Frequencies of any adverse event and of serious adverse events are similar to those reported for other routine childhood vaccines.^12-15,41-43

In infants and children <2 years of age, 3–23% of trial participants reported fever.^14,15,41-43

A large study in adolescents showed that most reactions were mild. The most common adverse events were:⁵¹ 

• pain at the injection site (44% of participants)
• headaches (29%) 
• myalgia (19%) 
• erythema (15%)

About 1% of vaccine recipients reported fever.

The frequency of adverse events did not increase when Menveo was administered with other routine vaccines in infants and young children^12-15,41 or adolescents.²² A slightly higher frequency of adverse events was observed when Menveo was co-administered with both HPV and dTpa vaccines in adolescents.

A large post-licensure safety study of adolescent vaccine recipients found a slightly higher risk of Bell’s palsy in vaccine recipients.⁴⁴ However, ongoing analysis of millions of people who received the vaccine did not find any safety signals for facial paresis.

Nimenrix

Clinical trials have shown Nimenrix to be safe for use in infants, children and adolescents.^{11,17,18,23,37-40} Most reactions were mild injection site reactions, which occurred in 30–50% of vaccine recipients. About one-fifth of people who were vaccinated had a mild systemic reaction.

In young children aged 12–23 months, the frequency of mild adverse events was slightly higher when Nimenrix was administered together with other routine childhood vaccines, particularly Infanrix hexa.^17,18 Studies on co-administration in adolescents did not show any difference in the frequency of adverse events between administration groups.²³

Menactra

The safety of Menactra has been widely established through both clinical trials and widespread vaccine use in the population, particularly in adolescents. Clinical studies do not show any safety concerns.

Most reactions are local injection site reactions.^35,51-55 3.2–4.8% of adolescents had systemic symptoms. These were mostly mild and most commonly:³⁵

• headache
• fatigue
• malaise
• arthralgia
• diarrhoea
• anorexia

4.7–11.4% of children aged 2–10 years had fever.^52,53

Studies of concomitant administration in adolescents showed that Menactra can be safely co-administered with 9vHPV (9-valent human papillomavirus) and dTpa vaccines. However, injection site reactions were more frequent at the site of 9vHPV injection when co-administered with Menactra.^25,26,56

A large study of >31,000 adolescents and adults aged 11–55 years who received Menactra in the United States did not raise any safety concerns.⁵⁷

MenB vaccines

Bexsero

Bexsero has an acceptable safety and tolerability profile based on clinical trial data.

In clinical trials, fever was the most notable systemic reaction in infants and young children, particularly those aged 2–12 months. Temperatures were highest 6 hours after vaccination, then decreased on day 2 and generally subsided by day 3.²⁹ More than a quarter (26–41% depending on dose number) of infants who received Bexsero alone developed fever ≥38°C, and 4–8% had fever ≥39°C.³⁰

In response to a community epidemic in Quebec, Canada, around 44,000 individuals between 2 months and 20 years of age received at least 1 dose of Bexsero. About 15% (112/746) of infants who participated in the vaccine safety surveillance reported fever. Among 61 infants who had their temperature measured in the first 48 hours, around 32% reported a peak temperature of 39–40.4°C. <1% reported a peak temperature of ≥40.5°C.³²

Safety surveillance (from September 2015 to 31 May 2017) of a national routine vaccination program for children aged 2–18 months using Bexsero in the United Kingdom found no unexpected adverse reactions except for reports that described a local reaction with a persistent nodule at the site of injection, usually without other symptoms.⁵⁸ There was no increase in the frequency of febrile seizures or convulsions in infants who received Bexsero.⁵⁹

In a clinical trial, the frequency of fever was about 2 times higher when infants received Bexsero with other infant vaccines, specifically DTPa-hepB-IPV-Hib vaccine and 7vPCV (7-valent pneumococcal conjugate vaccine). 51–62% of these infants reported fever ≥38°C, and 10–15% reported fever ≥39°C within 7 days of any vaccine dose.³⁰

Prophylactic paracetamol reduced fever in infants who received Bexsero at the same time as other routine infant vaccines.³¹ (See also Contraindications and precautions). In clinical studies, fever and other systemic reactions were less common after the booster dose of Bexsero received at 12 months of age.

Other common adverse events after receiving Bexsero included:²⁹

• tenderness, swelling, induration and erythema at the injection site
• irritability
• sleepiness
• unusual crying
• change in appetite

These reactions were reported less often with increasing age.

Adolescents and adults most commonly reported:⁶⁰

• pain at the injection site
• malaise
• headache

Trumenba

Several studies report safety and tolerability for Trumenba.^60-63 There was no significant increase in serious adverse events among more than 4250 people aged 10–25 years who received at least 1 dose of Trumenba.

The most common adverse reactions in these studies were:

• pain at the injection site (≥85%)
• fatigue (≥40%)
• headache (≥35%)
• myalgia (≥30%)
• chills (≥15%)

Most reactions were mild to moderate in severity and did not increase with subsequent doses of Trumenba. The safety profiles were similar for the 3-dose and 2-dose schedules.

MenC vaccines

NeisVac-C

Data from clinical trials in England showed that transient headache of mild to moderate severity was the most commonly reported adverse event. This was more common in older adolescents than in younger children in primary school.⁶⁷

Most local reactions were pain or redness at the injection site. These were mostly mild and resolved on their own.

Post-licensure passive safety surveillance data from the United Kingdom showed that the most commonly reported adverse events were:^68-71

• transient headache
• fever
• local reactions
• dizziness

Meningococcal disease is caused by the bacterium Neisseria meningitidis. The bacterium is commonly known as meningococcus.

There are 13 known meningococcal serogroups, distinguished by differences in surface polysaccharides of the bacterium’s outer membrane capsule. Globally, serogroups A, B, C, W and Y most commonly cause disease.

Pathogenesis

Humans are the only reservoir of Neisseria meningitidis.

Some people carry N. meningitidis without developing disease. The prevalence and duration of asymptomatic nasopharyngeal carriage of meningococcus vary over time, and in different populations and age groups. Prevalence of carriage is higher when groups of people occupy small areas of living space.^72,73

The incubation period is between 2 and 10 days, but commonly 3–4 days.⁷⁵

People at increased risk of invasive meningococcal disease

Some medical conditions increase a person’s risk of developing invasive meningococcal disease (IMD). The magnitude of the risk varies with the primary underlying condition.

People with a complement deficiency have a 5–10,000-fold increased risk of meningococcal disease, depending on the specific condition. People with a complement deficiency are also more likely to become infected again.^75,76 

People with an absent or dysfunctional spleen have a lifelong increased risk of severe bacterial infection,^77,78 including meningococcal sepsis.

Other immunocompromising conditions that increase the risk of IMD include HIV^79,80 and haematopoietic stem cell transplant.

Other people at greater risk of meningococcal infection include:

• laboratory workers who handle meningococcus
• new military recruits^6,81
• university students living in residential colleges (particularly in their 1st year)^5,7,82,83
• smokers^10,73

A person’s risk of acquiring meningococcal disease can also increase by:^{10,72,73,84-86} 

• exposure to cigarette smoke and smokers (who are more likely to carry meningococcus)
• intimate kissing with multiple partners
• recent or current viral infection of the upper respiratory tract

There is no definitive evidence that there is an increased risk of IMD among men who have sex with men. However, clusters or community outbreaks of serogroup C IMD among men who have sex with men have been reported.^87-91 

Transmission

Meningococcus is transmitted via droplets or direct contact.⁷⁵

Symptoms of meningococcal disease

Neisseria meningitidis can cause invasive meningococcal disease (IMD), which usually presents as meningitis and septicaemia. Septicaemia, either on its own or with meningitis, can be particularly severe. N. meningitidis can also cause other localised infections, although these are less common, including:^74,84

• pneumonia
• arthritis 
• conjunctivitis

The clinical manifestations of meningococcal septicaemia and meningitis may be non-specific.

They can include:⁸⁵

• sudden onset of fever
• rash (petechial, purpuric or maculopapular)
• headache
• neck stiffness
• photophobia
• altered consciousness
• muscle ache
• cold hands
• thirst
• joint pain
• nausea
• vomiting

Not all symptoms or signs may be present at disease onset.

The characteristic rash of meningococcal disease does not disappear with gentle pressure on the skin, but the rash is not always present.

IMD can also present atypically as:

• septic arthritis
• pneumonia
• epiglottitis

These atypical presentations are more common among certain serogroups, especially serogroup W.

Complications of meningococcal disease

Meningococcal infections can progress rapidly to serious disease or death in previously healthy people. The overall mortality risk for IMD is high (5–10%), even if the person receives appropriate antibiotic therapy.

Around one-third of children and adolescents who survive IMD develop permanent sequelae. These can include:⁸⁴ 

• limb deformity
• skin scarring
• deafness
• neurologic deficits

Around 30–40% of people who survive IMD have long-term consequences or disabilities. Patients and caregivers can also have psychological symptoms due to these sequelae.^92-94

Meningococcal disease in Australia

Meningococcal disease can occur sporadically or in epidemics. In Australia, most cases occur during winter and early spring. Other countries with temperate climates also have this seasonal trend.⁹⁵

The meningococcal serogroups that cause meningococcal disease have been changing. A meningococcal C vaccine was introduced on the National Immunisation Program in 2003 and has resulted in a large reduction in meningococcal C disease incidence.^95,96

Meningococcal B has historically caused most meningococcal disease in Australia.⁹⁶ Meningococcal B continues to cause around half of all reported cases of meningococcal disease in Australia.⁹⁸

Meningococcal B is most common in South Australia, where a state-funded MenB vaccination program was introduced from 2018. Refer to the South Australian Health Department website for further details.

Because of substantial declines in invasive meningococcal disease (IMD) caused by serogroups B and C, overall IMD incidence in Australia declined between 2003 and 2013.⁹⁶

Since 2013, the incidence of meningococcal W disease has rapidly increased.^98,99 Incidence of meningococcal Y disease has also been steadily increasing since 2016.⁹⁸ Several states and territories implemented vaccination programs with MenACWY vaccine in 2017 to manage this disease. In 2018, MenACWY vaccine was introduced on the National Immunisation Program for toddlers aged 12 months. Adolescents are able to receive MenACWY vaccine on the National Immunisation Program from 2019. 

Risk by age group, and by Aboriginal and Torres Strait Islander status

Children aged <2 years

Children aged <2 years have the highest incidence of meningococcal cases. The disease occurs most often in infants aged 3–5 months.

Adolescents aged 15–19 years

A high number of meningococcal disease cases occurs among adolescents and young adults aged 15–24 years, with peak rates of disease occurring in 18–20-year-olds. Adolescents and young adults have the highest rate of meningococcal carriage and are thought to play an important role in transmitting the bacteria in a community.⁴

Adolescents and young adults in this age bracket who have a higher risk of acquiring the meningococcal bacteria are:

• people who live in close quarters, such as new military recruits and students living in residential accommodation
• people who have prolonged contact with a person who is carrying meningococcal bacteria^5-7
• people who are smokers^8-10 

Aboriginal and/or Torres Strait Islander people

Aboriginal and Torres Strait Islander people have much higher incidence rates of meningococcal disease than non-Indigenous Australians.⁹⁶ This is particularly among children aged <15 years for the 2 most common meningococcal serogroups: B and W.

During 2012–17, the incidence rate of meningococcal disease caused by serogroup W was higher in Aboriginal and Torres Strait Islander children aged <5 years than in non-Indigenous children of the same age (3.10 versus 0.34 per 100,000; rate ratio 9.1). This disparity was even more striking in 2016–17, when meningococcal disease rates among Aboriginal and Torres Strait Islander people were more than 100 times the rates in non-Indigenous Australians in certain age groups. This has been partly due to an outbreak of serogroup W disease in Central Australia. The outbreak started in September 2017, and particularly affected Aboriginal and Torres Strait Islander people aged <10 years in remote communities.¹⁰¹

There is a longstanding trend of higher serogroup B meningococcal disease rates in Aboriginal and Torres Strait Islander people than in non-Indigenous Australians, particularly among children <5 years of age. Between 2006 and 2015, rates of meningococcal disease caused by serogroup B disease were reported as being 3.4 times and 3.8 times higher among Aboriginal and Torres Strait Islander infants aged <12 months and children aged 1–4 years, respectively, compared with non-Indigenous infants and children of the same age.⁹⁶

Invasive meningococcal disease (IMD) is a rare condition. Because of this, studies to assess the effectiveness of a vaccine in preventing IMD are not feasible because very large numbers of people would need to be vaccinated and followed up over long periods of time.

As an alternative, studies measure the immune response to meningococcal vaccines, which indicates how effective the vaccine is likely to be. An immune response is considered to have occurred if antibodies are detected above a standard threshold that is likely to be protective against the disease.

Meningococcal B vaccines

Trumenba (MenB-fHBP)

People aged 11–18 years show good immune responses after receiving 2 doses of Trumenba 6 months apart. They also show good immune responses after receiving 3 doses of Trumenba using a 0, 1–2-month and 6-month vaccination schedule.⁶¹ 

Protective immune responses were seen in: 

• 82–83% of trial participants after 3 doses received at 0, 1 and 6 months, or 0, 2 and 6 months 
• 73.5% of participants after 2 doses received at 0 and 6 months

Several clinical trials in people aged 10–25 years have also shown that both 3-dose and 2-dose schedules are safe and can be administered with other vaccines.^60-63,101

Bexsero (MenB-MC)

Bexsero induces bactericidal antibodies specific to the 4 vaccine antigens in infants, children, adolescents and younger adults. Antibody levels correlate with protection against clinical disease.^{29,30,59,102,103}

Bexsero is expected to protect against most circulating meningococcal B strains. Specialised laboratory testing (Meningococcal Antigen Typing System, or MATS) has predicted that around 75% of all meningococcal B strains that caused disease in Australia from 2007 to 2011 would have been susceptible to effective killing by vaccine-induced antibodies.¹⁰⁵

Data on vaccine effectiveness are available from the United Kingdom, where a routine infant program using a reduced dosing schedule was introduced in 2015. The vaccine effectiveness of 2 doses given at 2 and 4 months of age was 82.9%.¹⁰⁵

Meningococcal conjugate vaccines

Conjugate meningococcal vaccine formulations contain meningococcal serogroup antigens that are joined (conjugated) to a carrier protein. Because each of the 3 MenACWY vaccines contains different conjugate carrier proteins, they produce different levels of immune response. It is not known whether these differences affect a person’s protection against meningococcal disease. However, a stronger immune response, measured by antibody levels, is likely to predict better protection against the disease.

Menveo (MenACWY-CRM)

Menveo is safe to use in children from 2 months of age.^12-14,41 When given in a 3-dose schedule at 2, 4 and 12 months of age, more than 99% of children in a clinical trial developed protection against meningococcal W and Y after they completed the course.¹⁴ 

For children who start vaccination at age 6 months to <12 months, a 2-dose schedule with Menveo produces a good immune response. In a large study with more than 1600 participants, more than 96% of children who received 2 doses of Menveo at age 7–9 months and 12 months developed protection against meningococcal C, W and Y.¹⁵

Another smaller study showed that 100% of children who received Menveo at 6 and 12 months of age produced an immune response against meningococcal C, W and Y after the 2nd dose.⁴³

Although Menveo is registered in a 2-dose schedule from 7 months of age, data from these clinical trials showed that the immune response in children who started vaccination at 6 months of age was similar.

97% of children aged 12–23 months who received Menveo developed a protective immune response to all 4 meningococcal serogroups after 2 doses.⁴¹

2 large studies in adolescents showed good immunity after vaccination with Menveo.^22,51 Supporting studies in adolescents and adults also found that more than 80% of people developed an immune response to all 4 meningococcal serogroups.^22,45,106

Nimenrix (MenACWY-TT)

When Nimenrix was given in a 3-dose schedule at 2, 4 and 12 months of age in a clinical trial, more than 99% of children developed protection against all 4 meningococcal serogroups after completion of the course.²⁰

In another study of Nimenrix given at 6 and 15–18 months of age, 94% of children developed an immune response against all 4 meningococcal serogroups after the 1st dose at 6 months, and all but 1 out of 139 vaccinated subjects had a protective response to all 4 serogroups after the booster dose in the 2nd year of life.²¹ In another study, a 2-dose schedule of Nimenrix given at 9 and 12 months of age produced immune responses against all 4 serogroups in 98% of vaccinated infants after the 1st dose and in all children after the 2nd dose.¹⁹

1 dose of Nimenrix produces a strong immune response in children aged 12–23 months. More than 97% of children developed an immune response against all 4 serogroups (A, C, W and Y).^11,17,18,37 

A large trial in adolescents showed that 85.4–97.4% of participants had a vaccine response following vaccination with Nimenrix, depending on the serogroup. Almost all participants had evidence of immunity against the 4 vaccine serogroups.⁴⁰ Other studies have also demonstrated good immune responses after vaccination with Nimenrix, either alone or with other vaccines.^23,38,39,107

Menactra (MenACWY-D)

Menactra induces an immune response against serogroups A, C, W and Y in both children aged ≥2 years^52,54,55,108 and adolescents.^35,38,51

Among infants and children aged 9–23 months, 2 doses of Menactra are needed for a protective immune response. In a small study of infants aged 9 months who were given 1 dose of Menactra, the proportion of infants who had an immune response was low, especially against serogroups W and Y (20–27% of children). However, after a 2nd dose was given at either 12 or 15 months of age, more than 92% of children had an immune response against serogroups C, W and Y, and 89% had an immune response against serogroup A.¹¹⁰ A larger study showed similar results, although the proportion of children who had an immune response against serogroup W was slightly lower (81–88%).⁵⁴

Menactra is also immunogenic in people with HIV and other people who are immunocompromised, when they receive 2 doses.^47,110,111

Population data collected in the United States showed that Menactra was 80–85% effective in preventing clinical infection in a population during the 1st year after vaccination.^112-114 However, immunity appears to wane over the first 8 years after vaccination.

Clinical trials among children aged ≥2 years and adolescents indicate that the level of antibody response after a dose of Menveo or Nimenrix is modestly higher than after a dose of Menactra, especially for meningococcal serogroups W and Y.^{38,51,115,116} There is also some evidence that immunity decreases more quickly with Menactra than with Menveo or Nimenrix.^38,115,117

NeisVac-C (MenC-TT)

Most clinical trials of NeisVac-C involved co-administration with other routine vaccinations. These trials demonstrate that NeisVac-C induces a good immune response against serogroup C.⁶⁷

Post-licensure data from the United Kingdom MenC vaccination program show that 1 dose in young children is 83–100% effective.^68,118 This program used a combination of MenC vaccines.
The Netherlands and Iceland used NeisVac-C exclusively in their MenC vaccination programs. Data from these countries showed falling rates of serogroup C cases among both vaccinated and unvaccinated people, and no vaccine failures among vaccinated people.^119,120

The population-wide use of NeisVac-C in national vaccination programs has resulted in marked reductions in serogroup C invasive meningococcal disease in the eligible age groups, including in Australia.^68,95,118 Although antibody levels wane after vaccination with meningococcal C conjugate vaccines,^121-123 current serogroup C meningococcal disease epidemiology in Australia suggests ongoing protection in age groups who were previously vaccinated.⁹⁵

For all meningococcal vaccines, transport according to National vaccine storage guidelines: Strive for 5.¹²⁸ Store at +2°C to +8°C. Do not freeze. Protect from light.

MenACWY vaccines

Menveo must be reconstituted. Add the entire contents of the liquid MenCWY vial to the lyophilised MenA vial and shake vigorously until the powder completely dissolves. Use reconstituted vaccine as soon as practicable. If it must be stored, hold at +2°C to +8°C for no more than 24 hours.

Nimenrix must be reconstituted. Add the entire contents of the pre-filled syringe or ampoule of solvent to the vial and shake well until the powder completely dissolves. Use reconstituted vaccine promptly. Reconstituted vaccine is stable at temperatures up to 30°C for up to 8 hours.

MenB vaccines

Bexsero is supplied as a suspension for injection in a 1.0 mL (Type I glass) pre-filled syringe. A fine off-white deposit may form in the syringe after storage. Shake the vaccine well before use to form a homogeneous suspension.

Trumenba is supplied as a white suspension in a pre-filled syringe. Shake the vaccine vigorously to obtain a homogeneous white suspension. Do not use the vaccine if it cannot be resuspended.

MenC vaccines

NeisVac-C is supplied as a semi-opaque white to off-white suspension in a pre-filled syringe. Shake the vaccine thoroughly to obtain a homogeneous suspension.

Invasive meningococcal disease is a notifiable disease in all states and territories in Australia.

Prompt diagnosis and medical treatment of suspected cases of meningococcal disease are critical.

The Communicable Diseases Network Australia national guidelines for invasive meningococcal disease¹²⁹ have details about the management of cases and contacts.

Local and state and territory public health authorities can provide further advice about the public health management of meningococcal disease.

The local, state or territory public health authorities will decide whether vaccination is needed for:

• close contacts of a meningococcal disease case, such as people with household or household-like contact
• people in an institutional or community setting during a meningococcal disease outbreak

These decisions will be made according to the national guidelines.¹²⁹

The product information for all meningococcal vaccines states that there are no data on the use of these vaccines in lactating women. The Australian Technical Advisory Group on Immunisation (ATAGI) recommends that breastfeeding women can receive meningococcal vaccines.

Menveo

The product information for Menveo states that the vaccine is for use in people aged ≥2 months. ATAGI recommends that the vaccine can be given to people aged ≥6 weeks.

Menactra

The product information for Menactra states that this vaccine is for use in people between 9 months and 55 years of age.

ATAGI recommends that this vaccine can be given to people >55 years of age as a single dose.

The product information for Menactra states that this vaccine should be administered as a 2-dose primary schedule, 3 months apart, to children aged 9–23 months of age.

ATAGI recommends that this vaccine can be given as a 2-dose primary schedule, 8 weeks apart, to children aged 9–23 months of age.

The product information for Menactra states that a previous episode of Guillain–Barré syndrome is a contraindication to vaccination with Menactra. 

ATAGI recommends that a person with a history of Guillain–Barré syndrome can receive any of the available MenACWY vaccines.

Menveo, Nimenrix and Menactra

The product information for Menveo, Nimenrix and Menactra states that vaccine should be administered as a single dose to people aged ≥2 years. 

ATAGI recommends that these vaccines can be given in a 2- or 3-dose primary schedule to people aged ≥2 years who are at increased risk of invasive meningococcal disease according to Table. Recommendations for MenACWY vaccine for people with a specified medical condition that increases their risk of invasive meningococcal disease.

Bexsero

The product information for Bexsero states that this vaccine is for use in people aged ≥2 months. ATAGI recommends that this vaccine can be given to people aged ≥6 weeks.

The product information for Bexsero states that for infants aged 2–5 months the third (booster) dose should be given in the second year of life (age 12 months or later) with an interval of at least 6 months between the primary vaccination series and the booster dose.

ATAGI recommends that infants aged 6 weeks to 5 months should receive the third (booster) dose at age 12 months or 8 weeks after the second dose, whichever is later.

The product information for Bexsero states that children aged 2–10 years at start of vaccine course should receive 2 primary doses, with an interval not less than 1 month between doses.

ATAGI recommends that children aged 2–10 years at start of vaccine course should receive 2 primary doses, with an interval not less than 8 weeks between doses.

The product information for Bexsero states that adolescents and adults aged ≥11 years at start of vaccine course should receive 2 primary doses, with an interval not less than 1 month between doses.

ATAGI recommends that adolescents and adults aged ≥11 years at start of vaccine course should receive 2 primary doses, with an interval not less than 8 weeks between doses.

Trumenba

The product information for Trumenba states that people aged ≥10 years with a specified medical condition associated with increased risk of meningococcal disease should receive 2 doses, at least 1 month apart, followed by  a third dose at least 4 months after the second dose.

ATAGI recommends that people aged ≥10 years with a specified medical condition associated with increased risk of meningococcal disease should receive 2 doses, at least 1 month apart, followed by a third dose at least 6 months after the first dose.

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